The Center for Health Literacy Promotion (CHLP) used one of AHRQ's health literacy resources—the Patient Education Materials Assessment Tool (PEMAT)—to assess its six-booklet series, Beginnings Pregnancy Guide. The PEMAT is a systematic method to evaluate and compare the understandability and actionability of print and audiovisual patient education materials.

"We wanted to see if potential purchasers of Beginnings PregnancyGuide and health educators judge the information to be understandable and actionable for their service populations," explained Sandra Smith, Ph.D., M.P.H., director of CHLP. "In addition, we wondered if the PEMAT could be used by multiple reviewers assessing a more complex document like the pregnancy guide, which covers multiple topics."

CHLP is a research organization that helps adults use health information and services to promote health. The pregnancy guide focuses on key health behavior messages linked to pregnancy outcomes. The booklets are distributed one at a time over the course of pregnancy so that the information is always current for the intended reader. As part of CHLP's literacy review of the guide, each booklet was assessed by four or five reviewers representing users of patient education materials for vulnerable families.

"Program directors frequently find themselves faced with three or four good options for materials on a particular topic, trying to determine which set will be most understandable to the populations they serve," said Dr. Smith. "We found the PEMAT to be a useful tool to guide selection of patient education materials."

Using the PEMAT to assess whether the booklets' information leads to healthy behaviors is of particular importance to the CHLP.

"Ensuring that most intended readers will understand the material is important. However, if the material does not also support health-promoting action, it becomes what one mother described as 'just someone else's' words,'" Dr. Smith noted. "One of the best uses of the PEMAT for us is to identify elements to test directly with pregnant women. As producer of the materials, we would use the reviewers' ratings to design further testing with mothers."

Dr. Smith said reviewers' responses to the PEMAT assessment were consistent and positive. "Using this AHRQ tool, they found the Beginnings Pregnancy Guide to be both highly understandable and actionable. The series, Beginnings Pregnancy Guide and Beginnings Parents Guide, scored 95.6 percent and 98 percent, respectively, on the measures."